I was just diagnosed with OCD this week. The podiatrist that I saw brought in another one to my appointment to confirm. Now I need to decide to have a microscopic surgery or having a piece of cartilage taken from my knee to put in my foot. I'm so lost and have no idea what to do. I have an appointment tomorrow for 3rd opinion and hopefully to get some questions answered.

I'm scared to go with the first option since it may or may not work but the 2nd option seems like major down time and I have young children (5 & 7). I was hoping to make a decision right away so I can get this done ASAP. Since the summer is where I can get the most help from friends. After reading a few post and how much down time it is I may be better of waiting until the kids start school in the fall.

Can anyone recommend some questions for me to ask the Dr? Any help is appreciated.

Hi, Mrs. Heidi, and welcome to the Foot section of HealthBoards. I face the same choices, though I've delayed my decision for a year and just got my 3rd MRI to find out if I can dither longer or if it's panic time.

There are many things you could ask your doctor, but you could start with the following questions. Be warned that asking them all might drive your doctor(s) a little nutty.

How big is my OCD defect? (This should be on the imaging report.)

Is the bone underneath the defect healthy or cystic?

Which surgery would you do if you found this in your ankle? Or if you found this in your brother's, or sister's ankle?

If you do this arthroscopically, will you just clean it up (chondroplasty) or make the bone bleed (microfracture/drilling)?

If graft, will I need a malleolar osteotemy?

How many times have you done the arthroscopic microfracture surgery?

How many times have you done the autograft/OATS surgery?

Is getting the cartilage from my knee the best graft option?

(For Podiatrist only) Can you operate on my knee?

I can't speak firsthand for downtime, but you should expect 6 weeks of NWB either way. Generally graft downtime is longer because it usually requires an osteotemy with cast, so NWB and no ROM for 6 weeks and your muscles atrophy more. Plus your knee might hurt for a while. The MFx is also NWB for 6 weeks, but some doctors permit PWB as soon as 3 weeks and since you usually have a removable boot, you can begin NWB ROM exercises starting 2-10 days after surgery.

Whether you should do it while kids are in school or on vacation might depend on how understanding they are and if someone else can drop them at school. Do they have summer camps planned? If you can't drive or carry anything for 6-8 weeks, would you rather have the kids home to help you or have them in school so you can sleep/relax alone for half the day? During the school year, can your kids get ready for school in the morning themselves or with someone else's help? Is this your right or left ankle and is your car an automatic or manual?
Good luck tomorrow!

Thank you so much for the responding and your insight. It will definitely help when I head off to my appointment tomorrow. They may not like all the questions but for me it is necessary so I can make the right decision for my family.

I'm a SAHM so my kids do minimal camps during the summer and they'll be finished long before I have surgery. I know they'll be helpful while they are hear and luckily I have some great friends that will get them out of the house too so they won't be too bored. It is my right ankle and I drive a automatic.

Mine is right ankle too. I can left-foot-brake and tried driving both pedals in a rental car with my left foot. It's possible, but requires crossing my legs, which is not comfortable and might not be possible once I have the post-surgical boot on the right. One doc I consulted suggested renting a car with hand controls.

I'm writing up a long list of different OCD treatments, but despite all the options available, the two standard surgical treatments for this today are arthroscopic microfracture and OATS/allograft (in 10 years the standard might be different). OATS has a higher long-term success rate but MFx is an easier surgery and usually has a faster recovery.

My personal opinion (which is evolving) is try MFx first if OCD <1 sq cm (e.g. < 10x10mm), and go straight to OATS/allograft if OCD >2.5 sq.cm (e.g. > 10x25mm). If >1sq.cm and <2.5sq.cm, that's borderline, and I'm likely in that borderline area (pending new MRI). That might not be the right guideline for you--ask your doctor(s). There are several alternative treatments and some can be combined with MFx or OATS, but most are not covered by insurance.

I could probably drive if I can put my right foot over onto the passenger side. Not overly concerned about that for now.

The Dr's definitely didn't give me too much information when I talked to them Monday and since I had no idea what they were going to say I didn't have much question to ask. Now I've got pages of questions for the new Dr. I'll see tomorrow. I hope the time is taken to answer them as I don't want to leave until I have a better understanding so I can make an informed decision.

Just got back from seeing the Dr. He was very nice and took the time to answer my questions in a way that I can understand. My lesion is 7mm and the bone underneath is cystic.

This is a really hard decision to make. I'm leaning towards the arthroscopic since it is the least invasive and will be praying it does the job Which is what I told the Dr. today. He is going to confer with another Dr. he sometimes works with and will let me know what he thinks when I check back in with him next week. I'll play the waiting game for now and see what happens next week.

Sorry to hear of your recent diagnosis, I know how it feels as I am a fellow OCD'er myself.

I had my micro fracture in 07 and OATS 10 months later so I know what you are feeling. Having been on here for awhile, might I suggest something...

Do a search on here for 'OCD' or 'OATS' to read past threads from those of us who has been through it. At the time I was going through it there were 4 or 5 of us at the time sharing our stories which you might find helpful.

Also, I feel compelled to tell you one important thing I learned on these boards...while it is great for support know that no two peoples situations are identical so while reading what worked for one person might not work for you and what didn't work for them might be perfect for you. Only you and your doctor can make the decision.
(Admittedly I still read these boards occasionally and keep my mouth shut when occasional 'experts' appear to be able to quote odds- general odds don't work when our injuries are so individualized so please keep that in mind.)

If you do go onto OATS I can tell you that my OCD was large and I did have plugs taken from my knee, 2 in fact, and my knee never once bothered me and my plugs incorporated into my talus perfectly. Yes, I have developed arthritis in my ankle since, but unfortunately that is the nature of an ankle injury.

Also, don't get discouraged if you don't see many success stories posted - those people are off running around

Not sure if Kim was referring to me since I have quoted success odds on other threads. To me, odds and averages are exactly that--generalizations based on multiple patient outcomes. They can't predict what will happen nor what would have happened if a patient had made a different choice. I find them both useful and frustrating.

But generally I would agree with her. No two OCDs or patients are alike, and you should read some of the older threads about OCD. I am myself quite new to OCD but have been reading furiously.

Just wondering if any of you know what it means that the bone underneath is cystic? I also have this. I understand that a cyst can form from fluid leaking through the cartilage defect. Is this correct? What does that mean in terms of treatment? Is the option of microfracture still available?

No, my comment wasn't based on your other threads, just more of a general statement.

I did just read the other OCD thread on here and saw your post. I too had a tibial osteotomy with my OATS procedure and other than some pain in the first 2 weeks after surgery, never knew anything was done-no pain at all. I think the non union risk rates come from as you mentioned smokers and the non compliant patient. I know I was 8 weeks NWB as were the others going thru it at the time but you know there are always those who don't listen to doctors orders who I am sure don't comply. (micro fracture NWB was 6 weeks)

Good thing is that you know pretty quickly if the micro fracture helped. I never got any pain relief from it and at about 6 months we started to suspect OATS was in my future. 4 months after that I had it done.

It is a tough decision but based on my experience here at the Hospital for Special Surgery, most docs will recommend the drilling before OATS every time in the hopes it will work (and perhaps to help justify the subsequent need for OATS to the insurance companies). One note here - before proceeding to OATS make sure your insurance co will cover it as some consider it investigational.

Thanks for your input Kim, I'm definitely aware that no to people or medical problem are exactly the same. I mentioned the same thing to the Dr. this morning.

I'm working my way through some of the threads and the information is very helpful. There is just so many unknowns that is makes it hard to make the right decision. I'm sure it doesn't help that I can be indecisive when it comes to things either.

It is very encouraging reading that many of you are able to get back into some physical activity. I was taking 3-4 higher intensity aerobics classes a week until I was sent for the MRI. I'm having a hard time not exercising, but I have to learn how to be still before I head into surgery or I'll be screwed post-op.

I'm glad he asked me to think about it a bit more and not rush into it. After reading how well it has gone for many I almost want to go withe my first though of going straight to OATS, why put myself through 2 possible surgeries? So much to think about.

Kim, thanks for the insight. Part of my dilemma is I am not getting surgery for pain relief but only out of fear the OCD will continue growing. Two of the docs did say that my lesion is "borderline" in size between MF and OATS but both suggested trying MF first. My insurance puzzles me because their official published policy is that OATS is only covered for knees (and "investigational" for ankles), but when I phoned them they seemed to say it would be covered, minus copay, if the doctor were in-network (if out-of-network, they pay only 50%). Maybe it's a PPO thing.

MrsHeidi: Glad your doc took the time to explain. Good news is 7mm is fairly small for an OCD. My DPM didn't explain in detail until I peppered him with questions by email and his nurse asked me to make a 30-min appointment (most are 15 minutes) where he answered all the questions I had at the time. Of course since then, I've come up with more questions...

Cancellous (spongy) bone normally has lots of little holes. A bone cyst is a bigger hole that's not supposed to be there. Only one of my docs mentioned this, basically what you wrote--fluid is forced under joint pressure through the cartilage defect, causes bone resorbtion, and forms a cyst. After seeing your question, I found two papers which were a bit over my head but theorize this is the cause of subchondral cysts under OCDs in the ankle.

Not sure what it means for treatment. One doc said it means I should get OATS first instead of trying MFx, but the other 3 seemed to think MFx is still worth trying. Am I allowed to attach photos to posts? I'm trying to attach a CT photo of a bone cyst.

Quote:

Originally Posted by poppyg1

Just wondering if any of you know what it means that the bone underneath is cystic? I also have this. I understand that a cyst can form from fluid leaking through the cartilage defect. Is this correct? What does that mean in terms of treatment? Is the option of microfracture still available?

LivesNearCostco-thanks for the information on the cystic bone. I too found an article that was way over my head as is most medical stuff. I'm very grateful to have found this board as many things have been clarified by reading old posts.

Like you I'm going ahead with the surgery not so much for the pain as it is bearable(I rarely take anything for it) but to prevent further damage should it get bigger.

I'm still waiting to hear what my podiatrist hears from another Dr he consulted for a 3rd opinion.

I see so many saying they are being seen my a OS and I wonder if I should seek one out vs. a podiatrist? I have Kaiser insurance so I'm sure they'll allow me to do either. It is hard to really research much about the Dr's beyond the bio they have listed on the Kaiser website.

Good to hear you are not in pain as it gives you time to research. The OCD will grow in time, faster depending upon your activity level so you want to do something before you get to having no choice or beyond OATS straight to fusion.

If they think you have a shot at micro fracture working, I'd say go for it (actually I did!). Now granted, mine didn't work but that doesn't mean anything. Also I do think it is easier to get insurance approval for OATS if the drilling were tried first and quite honestly, the drilling in comparison to OATS is easy.

If you end up going for OATS please get proof that they'll cover it in a letter before. I read too many stories of people who had issues and that's the last thing you need to worry about when you are recovering.

It's funny you areca lot like me 4 years ago, I read everything I could and was the OATS Whisperer... Unfortunately since I have become the post traumatic osteoarthritis whisperer and honestly am just tired with whispering about this foot. Hopefully OATS will be your last surgery and you won't experience what I am.

Good luck and keep us posted!
Kim

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LivesNearStore (06-12-2011)